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Health Guide / GLP-1

How to get Wegovy covered by insurance

felix gussone

Reviewed by Felix Gussone, MD, written by Lindsay Modglin

Last updated: Jul 25, 2023
5 min read

table of contents

  1. What is Wegovy?
  2. How to get Wegovy covered by insurance 
  3. Do Medicaid or Medicare approve Wegovy?
  4. Wegovy cost with insurance vs. Wegovy cost without insurance
  5. Are there ways to save money on Wegovy?
  6. What are the side effects of Wegovy?

If you’re looking for a prescription weight loss solution that helps you reach your healthy weight goals, Wegovy (semaglutide; see Important Safety Information)

may be an option. While Wegovy has been proven very effective for chronic weight management, it may come with a hefty price tag. That’s why it is essential to understand insurance coverage options as well as alternatives to insurance coverage. If you’re wondering if Wegovy is covered by insurance, or how to get Wegovy covered by insurance, we’ll have the answers for you. 

Here’s what you need to know about insurance coverage for Wegovy. 

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What is Wegovy?

Wegovy (semaglutide) is a prescription weight loss medication approved by the Food and Drug Administration (FDA) for adults with obesity (BMI ≥ 30) or a BMI over 27 who also have at least one weight-related medical condition, such as type 2 diabetes or high blood pressure. 

This once-weekly injection mimics the hormone glucagon-like peptide-1 (GLP-1), which targets areas of the brain that regulate appetite and food intake. One 68-week trial found that Wegovy users lost an average of 14.9% of their body weight throughout the trial.

As with many weight loss medications, you should combine Wegovy usage with a healthy diet and exercise for best results. And to minimize side effects, it’s recommended to start with a weekly dosage of 0.25 mg of Wegovy and work up to 2.4 mg over 17 weeks. 

How to get Wegovy covered by insurance 

Wegovy insurance coverage varies depending on your specific health plan. Many commercial and private insurers cover weight loss medications like Wegovy, or at least parts of it. 

If you’re trying to get Wegovy or another GLP-1 medication covered by your health insurance, there are three important steps you can take: 

  1. Talk to your healthcare provider: Before checking insurance coverage for Wegovy, you need to make sure the medication is suitable for you. Talk to your doctor about whether Wegovy is the right choice, based on your medical history and weight management needs. Once you get a prescription for Wegovy or another weight loss medication, such as Saxenda, you can look into insurance coverage
  2. Check in with your insurance provider: Contact your health insurance provider to determine whether your plan covers the medication. Make sure you also ask about your insurance plan’s out-of-pocket costs, and if prior authorization is needed. Before contacting your insurance provider, you can review your health insurance plan’s drug list (also known as a drug formulary), which you can find in your plan information. 
  3. Don’t give up right away: If your insurance plan does not provide coverage for Wegovy, you may be able to request it with the help of your healthcare provider. Novo Nordisk offers a sample letter template they can use to request coverage. 

Alternatively, an online weight loss program such as Ro Body Program has a dedicated insurance concierge partner who will work to find you coverage for Wegovy, if the medication is right for you. They will take care of communicating with your insurance company and even handle the paperwork.

Do Medicaid or Medicare approve Wegovy?

Each state determines which prescription drugs they will include as part of their Medicaid program. As a result, drug coverage for Medicaid beneficiaries varies depending on the state in which you live. Contact your state Medicaid agency to determine whether your state’s Medicaid program covers Wegovy. 

As for Medicare, weight loss medications like Wegovy are usually not covered. However, you need to check your specific plan’s prescription medication coverage to find out for sure.

How much does Wegovy cost?

Wegovy • Last updated: Feb 24, 2023 • 8 min read

Wegovy cost with insurance vs. Wegovy cost without insurance

A package of Wegovy contains four pens, each pre-filled with a single dose of Wegovy, or about a month’s worth of the medication. Without insurance, the list price of Wegovy is $1,349.02 per package, which breaks down to $269.80 per week or $16,188.24 per year.

Your out-of-pocket cost with insurance depends on your insurance coverage. It’s important to include your prescription copay and deductible when determining how much your supply of Wegovy will cost after insurance covers their portion.

Regardless of your insurance plan, your provider may require prior authorization to receive coverage benefits. You may also need to try a less expensive weight loss medication before receiving approval for Wegovy. 

Are there ways to save money on Wegovy?

Even without health insurance, there are ways to save on Wegovy and bring down the cost of Wegovy. 

Wegovy savings card 

With a Wegovy savings card by Novo Nordisk, the manufacturer of Wegovy, you can receive a 28-day supply of your prescription medication for as little as $0 if you have private or commercial insurance with prescription drug coverage. However, certain eligibility requirements and restrictions apply. If your insurance doesn’t cover it or you pay cash for your prescription medications, you can save up to $500 per 28-day supply. If your commercial or private health insurance covers Wegovy, you can save up to $200 per 28-day supply. 

Prescription discount cards

Companies like GoodRx or SingleCare provide prescription discount cards or Wegovy coupons for Wegovy. For example, sites like GoodRx aggregate free Wegovy coupons that can be used at a variety of pharmacies — including Walgreens, CVS, and Walmart — enabling people to save between 7% to 34% on the retailer’s price. You can also talk to your pharmacist about prescription discount cards they may offer at the pharmacy. 

Compare pharmacy prices

Prescription drug prices can vary from pharmacy to pharmacy. To find the lowest price, call several local pharmacies and ask what their retail price is for Wegovy. If you plan to use your insurance, you may need to show the pharmacy your prescription and insurance card before they can provide a price. 

If you have insurance, but they don’t offer coverage for Wegovy, you can still compare pharmacy prices to find the best deal near you. Ask your pharmacist to run the cash price of Wegovy through the various pharmacy discount programs to find the lowest price.

Ozempic manufacturer assistance program

If you also have diabetes, you might qualify for the Novo Nordisk Patient Assistance Program (PAP). This program provides eligible patients with access to free diabetes medicine, which may include Ozempic (semaglutide; see Important Safety Information). Ozempic injections deliver the same medication as Wegovy but in smaller doses (0.25, 0.5 mg, and 1.0 mg). 

Talk to your healthcare provider about whether Ozempic is an option for you. Your care team will help determine the best treatment options and help you apply to the Novo Nordisk PAP if you qualify.

Ultimately, finding out whether your insurance plan covers Wegovy and how much it’ll cost comes down to reaching out to your insurance provider directly. But, even if they don’t cover it, the tips above may help you save money on this medication.

What are the side effects of Wegovy?

Just like most prescription drugs, Wegovy may cause side effects that range from mild to severe. In clinical trials, nausea, vomiting, and diarrhea were the most common side effects. 

Other common side effects of Wegovy include:

Potentially serious side effects of Wegovy may include:

  • Severe allergic reaction
  • Increased heart rate
  • Low blood sugar
  • Low blood pressure
  • Inflammation of the pancreas (pancreatitis)
  • Gallbladder problems
  • Kidney problems
  • Diabetic retinopathy

If you experience any of these serious side effects, contact your healthcare provider immediately. They may alter your medication dosage or change your care plan altogether to help reduce the severity of your side effects. 

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

References

  1. GoodRx. (2022). Wegovy prices, coupons & savings tips. Retrieved from https://www.goodrx.com/wegovy
  2. SingleCare. (2022). Wegovy coupons & prices. Retrieved from https://www.singlecare.com/prescription/wegovy
  3. U.S. Food and Drug Administration (FDA). (2021). Highlights of Prescribing Information Wegovy (semaglutide) injection. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/215256s000lbl.pdf 
  4. Wegovy.com. (2021). Wegovy coverage and savings. Retrieved from https://www.wegovy.com/coverage-and-savings/wegovy-savings-and-support.html 
  5. Wilding, J. P. H., Batterham, R. L., Calanna, S., et al. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989–1002. doi:10.1056/NEJMoa2032183. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33567185
felix gussone
Felix Gussone, MD

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.

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Important Safety Information for Wegovy®

Important Safety Information for Wegovy (semaglutide) injection

Warning: Risk of Thyroid C-Cell Tumors

  • In studies with mice and rats, semaglutide (the active ingredient in Wegovy and Ozempic) caused thyroid tumors, including thyroid cancer. It is not known if Wegovy will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people. Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. 
  • Do not use Wegovy if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

What is the FDA-approved use of Wegovy?

Wegovy is a glucagon-like peptide-1 (GLP-1) receptor agonist for chronic weight management, along with a reduced calorie diet and increased physical activity, for people with an initial body mass index (BMI) of:

  • 30 kg/m2 or greater (obesity) or
  • 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia).

Limitations of Use:

  • Wegovy should not be used in combination with other semaglutide-containing products or any other GLP-1 receptor agonist
  • The safety and efficacy of coadministration with other products for weight loss have not been established
  • Wegovy has not been studied in patients with a history of pancreatitis

Who should not use Wegovy?

 Do not use Wegovy if:

  • You or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
  • You have a known allergic reaction to semaglutide (the active ingredient in Wegovy or Ozempic).

How should Wegovy be administered? 

You can take Wegovy with or without food. The pre-filled injector pen is self-administered as a subcutaneous injection in the stomach, thigh, or upper arm once a week on the same day every week. Your Ro-affiliated provider will guide you on a treatment regimen that may include an increase in dose every four weeks. 

You should not change your dosing regimen or stop taking Wegovy as prescribed without discussing with your provider first. 

What should I tell my Ro-affiliated provider before using Wegovy?

  • Wegovy has certain drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements. 

Some medications to watch out for include:

  • Medications used to treat type 1 or type 2 diabetes, including insulin or sulfonylureas (such as Amaryl or Glucotrol XL)
  • Wegovy causes a delay in gastric emptying, so it has the potential to impact the absorption of medications that are taken by mouth at the same time. Your provider can guide you on how to schedule your medications.
  • Other GLP-1 medications, including Ozempic, Saxenda, Victoza, Byetta, or Bydureon
  • If you’re using other products for weight loss, including dietary supplements

It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:

  • Type 1 or type 2 diabetes
  • Thyroid cancer
  • Pancreatitis
  • Kidney disease
  • Diabetic retinopathy
  • Depression
  • Suicidal thoughts or behavior

Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. 

  • If you are pregnant: Wegovy should not be used during pregnancy. Based on animal studies, there may be potential risks to an unborn baby from exposure to Wegovy during pregnancy. There is no benefit to weight loss during pregnancy and it may cause harm to the unborn baby.
  • If you are a female or male of reproductive potential: Discontinue Wegovy at least 2 months before a planned pregnancy since the drug can stay in the bloodstream for a long time.
  • If you are breastfeeding: Wegovy was found in the milk of lactating rats. Tell your Ro-affiliated provider if you are breastfeeding before you start Wegovy.

Pregnancy registry: There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to semaglutide (the active ingredient in Wegovy and Ozempic) during pregnancy. Pregnant women exposed to semaglutide and healthcare providers are encouraged to contact Novo Nordisk at 1-800-727-6500.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death. 

What are the most serious side effects that I or a caregiver should monitor for when taking Wegovy?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects can occur with Wegovy. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Thyroid C-Cell Tumors: In mice and rats, semaglutide (the active ingredient in Wegovy and Ozempic) caused an increase in thyroid C-cell tumors, including medullary thyroid carcinoma (MTC). It is unknown whether Wegovy causes thyroid C-cell tumors in humans. There were cases of MTC reported in patients who took liraglutide (the active ingredient in Victoza and Saxenda) after the drug was put on the market. Wegovy is contraindicated in patients with a family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. 
  • Inflammation of Pancreas (Acute Pancreatitis): Monitor for signs of acute pancreatitis, including severe abdominal pain that does not go away, sometimes radiating to the back, with or without vomiting.
  • Acute Gallbladder Disease: Wegovy may cause gallbladder problems, including gallstones. Some gallbladder problems require surgery. Tell your provider right away if you have pain in your upper stomach, yellowing of skin or eyes (jaundice), fever, or clay-colored stools.
  • Low Blood Sugar (hypoglycemia): Wegovy lowers blood glucose. It can cause too low blood sugar in patients with type 2 diabetes who also take another glucose control medication. Monitor your blood sugar and watch out for signs of too low blood sugar such as dizziness, blurred vision, mood changes, sweating, or fast heartbeat.
  • Acute Kidney Injury: In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration) which may cause kidney problems to get worse. It is important for you to drink plenty of water to help reduce your chance of dehydration.
  • Serious Allergic Reactions: Stop using Wegovy right away if you experience symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, severe rash or itching, very rapid heartbeat, problems breathing or swallowing, or fainting or feeling dizzy.
  • Diabetic Retinopathy Complications in Patients with Type 2 Diabetes: If you have type 2 diabetes, tell your provider right away if you experience changes in vision.
  • Increase in Heart Rate: Tell your provider right away if you have a racing heartbeat while at rest. 
  • Suicidal Behavior and Ideation: You should pay attention to any mental health changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you.
  • Never Share a Pen: Pen-sharing poses a risk of infection. 

What are the most common side effects of Wegovy?

  • Nausea
  • Diarrhea
  • Vomiting
  • Constipation
  • Abdominal pain
  • Headache
  • Fatigue
  • Dyspepsia
  • Dizziness
  • Abdominal distension
  • Eructation
  • Hypoglycemia in patients with type 2 diabetes
  • Flatulence
  • Gastroenteritis
  • Gastroesophageal reflux disease

You are encouraged to report negative side effects of prescription products:

This information is not comprehensive. Please see the full Prescribing Information for complete safety information. 

Important Safety Information for Ozempic®

Important Safety Information for Ozempic (semaglutide) injection

Warning: Risk of Thyroid C-Cell Tumors

  • In studies with mice and rats, semaglutide (the active ingredient in Ozempic and Wegovy) caused thyroid tumors, including thyroid cancer. It is not known if Ozempic will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people. Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. 
  • Do not use Ozempic if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

What is the FDA-approved use of Ozempic?

Ozempic is a glucagon-like peptide-1 (GLP-1) receptor agonist that is used:

  • with diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus.
  • to reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes mellitus and established cardiovascular disease.

Limitations of Use:

  • Ozempic has not been studied in patients with a history of pancreatitis.
  • Ozempic is not for treatment of type 1 diabetes mellitus.

Your Ro-affiliated provider may recommend the use of Ozempic as treatment for chronic weight management (obesity or overweight).

Who should not use Ozempic?

Do not use Ozempic if:

  • You or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
  • You have a known allergic reaction to semaglutide (the active ingredient in Wegovy or Ozempic). 

How should Ozempic be administered? 

You can take Ozempic with or without food. The pre-filled injector pen is self-administered as a subcutaneous injection in the stomach, thigh, or upper arm once a week on the same day every week. Your Ro-affiliated provider will guide you on a treatment regimen that may include an increase in dose every four weeks. 

You should not change your dosing regimen or stop taking Ozempic as prescribed without discussing with your provider first.  

What should I tell my Ro-affiliated provider before using Ozempic?

  • Ozempic has certain drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements. 

Some medications to watch out for include:

  • Medications used to treat type 1 or type 2 diabetes, including insulin or sulfonylureas (such as Amaryl or Glucotrol XL)
  • Ozempic causes a delay in gastric emptying so it has the potential to impact the absorption of medications that are taken by mouth at the same time. Your provider can guide you on how to schedule your medications.
  • Other GLP-1 medications, including Wegovy, Saxenda, Victoza, Byetta, or Bydureon
  • If you’re using other products for weight loss, including dietary supplements

It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:

  • Type 1 or type 2 diabetes
  • Thyroid cancer
  • Pancreatitis
  • Kidney disease
  • Diabetic retinopathy
  • Depression
  • Suicidal thoughts or behavior

Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. 

  • If you are pregnant: Ozempic should not be used during pregnancy. Based on animal studies, there may be potential risks to an unborn baby from exposure to Ozempic during pregnancy. There is no benefit to weight loss during pregnancy and it may cause harm to the unborn baby. 
  • If you are a female or male of reproductive potential: Discontinue Ozempic at least 2 months before a planned pregnancy since the drug can stay in the bloodstream for a long time.
  • If you are breastfeeding: Ozempic was found in the milk of lactating rats. Tell your Ro-affiliated provider if you are breastfeeding before you start Ozempic.

Pregnancy registry: There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to semaglutide (the active ingredient in Ozempic and Ozempic) during pregnancy. Pregnant women exposed to semaglutide and healthcare providers are encouraged to contact Novo Nordisk at 1-800-727-6500.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking Ozempic? 

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects can occur with Ozempic. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Thyroid C-Cell Tumors: In mice and rats, semaglutide (the active ingredient in Ozempic and Ozempic) caused an increase in thyroid C-cell tumors, including medullary thyroid carcinoma (MTC). It is unknown whether Ozempic causes thyroid C-cell tumors in humans. There were cases of MTC reported in patients who took liraglutide (the active ingredient in Victoza and Saxenda) after the drug was put on the market. Ozempic is contraindicated in patients with a family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. 
  • Inflammation of Pancreas (Acute Pancreatitis): Monitor for signs of acute pancreatitis, including severe abdominal pain that does not go away, sometimes radiating to the back, with or without vomiting.
  • Diabetic Retinopathy Complications in Patients with Type 2 Diabetes: If you have type 2 diabetes, tell your provider right away if you experience changes in vision.
  • Never Share a Pen: Pen-sharing poses a risk of infection. 
  • Low Blood Sugar (hypoglycemia): Ozempic lowers blood glucose. It can cause too low blood sugar in patients with type 2 diabetes who also take another glucose control medication. Monitor your blood sugar and watch out for signs of too low blood sugar such as dizziness, blurred vision, mood changes, sweating, or fast heartbeat.
  • Acute Kidney Injury: In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration) which may cause kidney problems to get worse. It is important for you to drink plenty of water to help reduce your chance of dehydration.
  • Serious Allergic Reactions: Stop using Ozempic right away if you experience symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, severe rash or itching, very rapid heartbeat, problems breathing or swallowing, or fainting or feeling dizzy.
  • Acute Gallbladder Disease: Ozempic may cause gallbladder problems, including gallstones. Some gallbladder problems require surgery. Tell your provider right away if you have pain in your upper stomach, yellowing of skin or eyes (jaundice), fever, or clay-colored stools.
  • Increase in Heart Rate: Tell your provider right away if you have a racing heartbeat while at rest. 
  • Suicidal Behavior and Ideation: You should pay attention to any mental health changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you.

What are the most common side effects of Ozempic?

  • Nausea
  • Vomiting
  • Diarrhea
  • Stomach pain
  • Constipation

You are encouraged to report negative side effects of prescription products:

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.